title: Evaluation of levator function for efficacy of minimally invasive and standard techniques for involutional ptosis.
abstract: OBJECTIVE
  To evaluate clinical and anatomic outcomes of surgery for involutional ptosis using standard-length or small incisions in relation to preoperative levator function.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Sixty-three patients diagnosed with involutional ptosis who underwent surgical correction using a small or standard-length incision between November 2010 and December 2011 were reviewed; a single surgeon performed surgery using a small incision (8 to 10 mm) in 22 patients and a standard-length incision (20 to 22 mm) in 34 patients. All patients underwent standard preoperative ptosis evaluation with margin-to-reflex distance 1 and 2 measurements and levator function assessment. Patients were divided into 2 groups according to levator function (moderate: 5 to 10 mm; and good: >10 mm). Surgical success was evaluated based on the British Oculoplastic Surgery Society criteria.
  
  
  RESULTS
  Of 83 upper eyelids of 63 patients, surgery was performed using a small incision in 40 and a standard incision in 43. In patients with good levator function, surgical success was achieved with a small incision in 18 eyelids (94.7%) and a standard incision in 20 eyelids (95.2%; P = .91). In patients with moderate levator function, surgical success was achieved with a small incision in 14 eyelids (66.7%) and with a standard incision in 18 eyelids (81.8%; P = .04).
  
  
  CONCLUSIONS
  These findings indicate a similar surgical success rate in patients with good levator function, regardless of incision length. The surgical success rate in patients with moderate levator function was lower when using a small incision, perhaps because of decreased visualization and anatomic access.
authors.affiliation: Oculoplastic Unit, Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy. Electronic address: info@stefanoranno.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ranno
authors.affiliation: Oculoplastic Unit, Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Sacchi
authors.affiliation: Oculofacial Plastic and Reconstructive Surgery, Flaum Eye Institute, University of Rochester, Rochester, New York.
authors.forename: Mithra O
authors.initials: MO
authors.lastname: Gonzalez
authors.affiliation: Oculoplastic Unit, Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
authors.forename: Meher T
authors.initials: MT
authors.lastname: Ravula
authors.affiliation: Oculoplastic Unit, Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009801:Oculomotor Muscles / Q000502:physiology* / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult